PTSD and Fatigue: Is It Normal to Feel So Tired?

I received an email from a client last week; he was very upset. Usually, he’s the kind of guy who likes to travel on the drop of a dime but since PTSD began to control his life, he’s noticed that traveling takes an enormous toll on him.

After even the smallest trip, he wrote, “I have to sleep all the next day. Is this part of the PTSD profile?”

In a word: Yes.

Why PTSD Causes Fatigue

Let’s start with the mind/body connection. While modern medicine preaches the separation of your mind and body (I can’t tell you how many times my doctors said, “Your trauma that led to PTSD happened years ago, that can’t possibly be affecting you now!”), the truth is that your mind is capable of producing 50% more stress than your body can handle.

Think about that: If your mind is producing so much stress that your body can’t handle it, what will your body do? That’s right! Your body will let you know that your entire being is overly taxed. One way to do that is to feel enormously exhausted.

Then let’s add in depression. According to research, people who are depressed are more than four times as likely to experience inexplicable fatigue. Even without the research, I bet you know that from personal experience. You wake up in the morning feeling like the weight of the world is on your shoulders. Or as one client told me yesterday, “The thought of the day is just unbearable.” Carrying all of that load is exhausting! PTSD depression is particularly heavy. Often tied to issues that involve the past, present and future, plus topics that have to do with the very core of who you are, depression can weigh you down like cement boots in a swamp of quicksand. It won’t take long before you just feel ready to curl up and take a nap.

Now, let’s get more scientific about it all.Cortisol is the stress hormone you most need to understand. Useful during a trauma, cortisol helps desensitize us so we feel less pain, increases short-term memory function, and acts as a quick energy boost. All good things, right? But here’s the kicker:

When present in higher levels for a prolonged period of time cortisol can be responsible for memory loss, fatigue, and reduced serotonin levels. Typically high during and immediately after trauma, some studies have shown that cortisol levels actually decrease later in the presence of PTSD. (We’re all unique and different so the only way to know how cortisol might be affecting you is through the results of a quick blood test done at any lab as prescribed by your doctor.)

Scientifically speaking a little further: The adrenal system processes stress hormones, including cortisol. When there’s an overload on the adrenal system a survivor might experience a variety of symptoms such as fatigue, exhaustion and an overload of stress. While the medical community does not recognize adrenal fatigue as an accepted medical diagnosis, the symptoms can’t be denied. (Like cortisol, the effects of adrenal overload can be identified through a blood test.)

Whatever is going on with you – be it emotional, mental or physical in origin – the bottom line is that fatigue (and often inexplicable fatigue) very often accompanies symptoms of PSTD. If this is the case for you, be your own best friend.

Give yourself the rest your body calls for. Reduce the amount of running around and other over-stimulation you allow. Also, reach out to your personal and professional support system to help develop a schedule that both honors and respects the fatigue while also trying to reduce and even eliminate it through proper PTSD treatment.

Thank you for writing about this! I never knew about it, and that is probably a huge contributor to my constant fatigue as I suffer from PTSD as well as a few other things. Is there any way you know of to help with this type of fatigue? It gets in the way of my studies, and that’s without the coping mechanism I have of falling asleep when I don’t understand a question on homework. Heh…
But thank you – again! I really appreciate your work to help others. :]

@Chelsea – I think the best way to deal with the fatigue is to deal with the source of it. Namely, PTSD. How are you approaching your PTSD recovery? On a coping level, I would say to deal with the fatigue by building in time for naps but even as I write that I know that allowing yourself to sleep won’t change the coping mechanism of wanting to when your brain gets overloaded, which it can quite easily when it’s already coping with so much. Which brings me back to my original question! How are you approaching your PTSD recovery? Relieving the exhaustion will come from relieving the stress that PTSD creates. There are many treatment options, a sampling listed here: http://www.healmyptsd.com/treatment If you’re in college they usually have counseling services that are free/low cost to students….

I always thought the reason my partner was always in bed asleep was coz he was a lazy a** h*le. I do know he has PTSD but didnt know it was the tired factor aswell, now i know this i wont go on at him as much,wont stop me completly but a little.

@Christine — From the outside PTSD can look lazy for sure! So much of what goes on during this Invisible Illness is not something others can see or understand. While as a partner it’s good to motivate and inspire someone to do the work of recovery and living, it’s also fair to recognize the limitations that PTSD coping puts in place. Sounds like you’re off to find a good balance!

My 16 year young son james hung himself 2 years ago I am not the same woman ,I think of good memories they all end up with the same james hanging I found him I can’t cope no more I don’t want to socialize I don’t want to do anything I don’t leave the house everyday is a night mare I need help

@Julie — Your situation would, indeed, be enormously tough to bear and you would just want to isolate and be alone. I’m so sorry for your pain and I wish there was something I could do to help. There are many terrific treatments for PTSD and trauma. One of my favorites (I used it in my own recovery) is neuro-linguistic programming. Some of the top names in NLP, Paul McKenna and John Grinder, are in London. I don’t know how far from there you are, but you might look into meeting with them or their colleagues for help.

Julie, I am so sorry to hear about your loss. I also wish there was anything I could do to help yo ease the pain. I have PTSD due to domestic violence and it is terrible but your case really touched me. I will pray for you. I hope you are feeling better.

The same thing happened to me with my 20 year old daughter. I have survived and thrived. Meditation, mindfulness, and IADC (Google Induced After Death Communication). My sister and many others have also been greatly helped by these kinds of things. Bless you.

@Mo — Thanks for sharing your experience. When we share our stories we really strengthen the PTSD community and everyone in it. I’m so delighted to hear that you’re feeling better. What a gift. Meditation was HUGE for me. I still practice it today because of it’s scientific and spiritual benefits. Here’s to your continued forward motion….

I am a Hurricane Sandy Survivor.I live in Hard hit Long Beach, N.Y. less than a block away from the Ocean. and was at home, when the 17+ foot ocean surge came down my block and started to climb the stairs to my apartment. I didn’t know if I would live through the night. I was all alone, with no power. no phone or cell phone service. no running water. and did not know how long I would be trapped here.My car was destroyed by the Ocean Surge. so I could not leave.Eventually I was rescued and evacuated to friends.When I was finally able to return home , I retuned to a damaged home. and a City that was completely decimated. It was surreal. The streets were covered by so much sand that sanitation workers are STILL shoveling it off the streets 12 weeks later. The Curbs and sidewalks were filled with people’s possessions-including the WALLS of their homes. Our City is in ruins.Even the hospital was destroyed. My mind could hardly process that any of this had happened due to the scope of the damage.A number of homes burned down the night of the Hurricane. Many lost their entire homes, or their first floors. I have suffered great financial losses in terms of damages to home, vehicle etc etc.
and am now dealing with mold issues. It has been very overwhelming.
All things considered, I was functioning almost remarkably well-considering the magnitude of the trauma. both DURING and after the hurricane.for about a month or more. Suddenly , I was seized by such overwhelming exhaustion that I have been unable to even go to the supermarket to buy food. for a week or more at a time. As I also had respiratory symptoms,I thought I was ill, but I was too exhausted to go even go see a Dr. until today. when my Dr. suggested that my exhaustioni is “probably due to what you have been through.”
How do I know if I am physically ill or if the trauma has caused the exhaustion.
I am very glad to have found your article. The exhaustion is so crushing that I a nearly completely debilitated.Any advice as to how to proceed would be greatly appreciated. What kind of Dr. can I see to make sure that there is not a separte physical cause for my exhaustion?

@Deborah — I’m so sorry for what you’ve been through. As a native NYer my heart is with you all the way. You pose a great question. Here’re my thoughts:

1 – the mind is capable of producing 50% more stress than the body can handle; when the body overloads it does create physical symptoms (I experienced this to such a degree in my own PTSD journey that I was (erroneously) diagnosed with Celiac Disease, mercury poisoning and possible liver cancer, among other things.)

2 – now would be a good time to have a full physical exam with your primary care physician. Make sure to include a full blood panel test so that you can rule out any physical causes.

3 – in lieu of diagnosed physical ailments (and even with them, for example, chronic fatigue, fibromyalgia, etc.) now would be the best time to design your own individual trauma resolution program. There are many treatments for trauma and PTSD that are enormously effective. Take a look at the options here (by no means fully conclusive but some of my favorites) and get a sense of what’s available to you: http://www.healmyptsd.com/treatment

Thanks so much for your article! I recently went through quite a rough patch with my father being very ill, his wife not letting me know anything about his condition etc. Then my friend’s son hanged himself. Two days after that I was mugged by two men with a knife.

This was about a month and a half ago. I am suffering from extreme nightmares and am constantly exhausted. It doesn’t matter how much I sleep I am always tired.

The thing about the mugging is that it brought up a lot of past abuse I’ve been through and I want to know if “past PTSD” can affect “current PTSD” or does it have a “memory” that is stored somewhere in the brain?

@Penny — First, let me just say that I admire your courage and resilience. That was an enormous amount of trauma to handle in any amount of time much less such a short period of time.

What you’re describing is very common and the short answer is, yes. Past traumas and how they have or have not been resolved definitely affect current trauma and their effects. Long-term memory is stored both in the body and the mind so it makes perfect sense that, faced with a similarly experienced enormous feeling of fear or situation or sensation those earlier neural pathways holding past trauma could be activated in your present situation.

The good news is there are many ways to reduce the effects of all trauma and find your way to healing. If you’re interested, take a look here for ideas about recovery: http://www.healmyptsd.com/treatment.

Look into condition called, “complex PTSD”. It is still a bit of a controversy, but I am getting treatment through a psychiatrist and psychologist who practices “EMDR”. I know complex PTSD was the right diagnosis for me, specifically because of early, chronic trauma, then an incident of near death as an adult.

Adrenal fatigue is a term applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems. The term often shows up in popular health books and on alternative medicine websites, but it isn’t an accepted medical diagnosis.

Very helpful and informative site. 4 yrs ago I was involved in a tragic single car accident with my husband. He had to swerve to miss a moose that jump on the hwy without any warning. We rolled over 4 times. My husband died and I sustained injuries. I was forced to return to work on a gradual return to work 14 months after. This failed numerous times. Then the severe depression and now being slowly weaned off meds. I have been forced to work full time for almost a year and continuously battling everything including severe fatigue for 4 yrs now. This fatigue seems to be ignored by my professionals, and I can no longer deal with my daily work as I struggle to get up to go to work, struggle to find energy throughout the day and evening, weekends and even for my first time on vacation this summer since the accident. I struggled to do my work and to deal with my terrible loss with professionals. I now have a wonderful companion and am still having this terrible fatigue. I have a lot of natural vitamins and don’t feel like I am getting anywhere. I am exhausted of trying to fight this fatigue and trying to have a normal life. I don’t think I should be working in order to have a normal life, to permit me to use the little energy I have. I did have Wellbutrin and Effexor. Do you have any suggestions?

@Carole — For added energy from a holistic source I really love ADAPTEN-ALL, from Ortho Molecular Products. It’s a natural adrenal supplement that helped me enormously. Check with your physician if you have any medical conditions or on medication to see if this would be an appropriate supplement for you.

Hi Michele,
Thank you so much for your information in this blog. I came across it on a google search and even though I’m Canadian and our system up here is a bit different I found your blog ever so helpful and your writing style is phenomenally engaging! It is so wonderful to know that I am not alone in my fatigue, that I’m not being lazy, and that there is a logical explanation for why I’m so tired. I was diagnosed with C-PTSD after a series of work place violent incidents, an abusive relationship with my former husband, and childhood physical abuse. I am a single mother of two wonderful girls and I have been struggling with my expectations for myself and the reality of what my body is allowing me to do. It has been a year since I was first diagnosed, along with bipolar disorder. I have healed a lot since then through the help of counselling, medical care and CBT and medication. Since I have returned to work part-time, I have been immensely tired, for days afterward. I feel like I shouldn’t be this tired. As I struggle with hypervigilance, I’m wondering if that would be a factor as well? I also seem to lose my keys, etc. often on workdays. Your blog was so compassionately written that i feel i can allow myself to heal physically without being angry or frustrated with myself for being so tired. It also gives me hope that as I heal my seemingly endlesss fatigue will improve. Thanks again for your awesome blog! It is wonderful to find this information.

@Christie — I’m so glad you’re here! And very excited that the information on this blog has led you to some new insights about yourself. It sounds like not only did you discover that you’re experiencing something completely normal (including the lost keys on workdays, I hear that often!), buy it sounds like you’re already implementing a new level of self-kindness; that’s really important too. In fact, my next radio show is all about that. If you’d like more information about how to heal from experts in the field, tune into CHANGING DIRECTION, or listen to the archives any time for more new ideas and validation for what you’re experiencing: ChangeYouChoose.com/archives

You have enormous healing potential; the goal is learning to access it. Onward toward freedom!

I had suffered from PTSD my entire life and never knew it. Think Mommy Dearest on steroids. At 37, my anxiety was so high I thought it would kill me, so I finally sought out a therapist. I was lucky. He was very good and we managed to get my anxiety level down to a level where I could function. He put me on Clomipramine which is pretty intense, but it literally made it impossible for me to get anxious. After about 3 years, I was able to stop taking it as I had finally learned how not to feel that way. 5 years later, my husband dropped dead from an aneurism. That was rough, but I got through it. Then I changed jobs after being at my previous employer for 15 years. All was good until I wound up with a a manager that was much like my mother. Mentally abusive, moody and unpredictable. I started experiencing these debilitating periods of fatigue that would last for about a month. I couldn’t sleep, and when I did, I never felt refreshed. My bowels stopped moving. I felt like I had no blood pressure and must be dying. My mind was so foggy I couldn’t think straight. It happened about once a year for 5 years. I went to all kinds of doctors, including an endocrinologist… All inconclusive. No joy. My research pointed to adrenal fatigue but not a medically accepted diagnosis. Ugh. After putting together a timeline of all of my ‘crashes’, it always happened after an incident that caused a huge rush of adrenaline. I’m sure the PTSD was highly contributory as you know how over sensitive we are to threats, real or imagined. I lucked out again as I found a doctor that specialized in adrenal fatigue. I was very skeptical, but everything he said made sense. He ordered a saliva test that indicated my cortisol levels were plummeting after noon. I was also 52, so I had that going on as well. He put me on Adrenal-All, DHEA, bio identical progesterone, and bio identical testosterone. That was 18 months ago. When I was only 9 months into the therapy, I had an attempted burglary at my home while I was in the house. Talk about an adrenaline rush. Fortunately he couldn’t get in, and I was armed, and the perpetrator was caught. Afterwards I was like, oh no, I am surely going to crash tomorrow… I had crashed after much less intensive situations… But the crash never came. Had that happened the year before, I am certain I would have crashed and crashed hard. I would have been down for over a month. For the first time in 5 years, I came through a scare without crashing. I can’t tell you how relieved I was. If you’ve experienced these crashes, you know how terrifying they are. I went to an outfit called Bodylogic, MD, but there are many doctors that specialize in adrenal fatigue and bio identical hormone therapy. No, I am not affiliated with them or anyone else. Insurance won’t cover a dime, but it was well worth it. I know now that my PTSD led me straight into adrenal fatigue, it makes perfect sense. Your adrenals get so exhausted from the anxiety that adrenalin is all you have left. If something happens that makes you dump all of your adrenaline, you crash. Hopefully someday the mainstream medical community will recognize it, but for now, you basically have to diagnose yourself.

I have been to Iraq 2 times and always tired been to marriage counseling and the counselor I have anxiety issues constantly worrying about things. Needless to say my wife and I has separated 3 times since 2010 and are heading towards a divorce

Ok look. I’m no expert. About two years ago I went through something that caused my mind and body a lot of trauma. I began to expirience a lot off horrible symptoms about three months after the last of the trauma.
After studying a lot I came to a conclusion that I had created a serious adrenal problem
I have concluded that Dp/DR. Kundalini awakenings, PTSD and im sure a lot of other Conditions share these similar symptoms
For me
Existential thoughts
Paranoia
Weird body sensations
Floating arms
Itching crawling
Left eye going bad
Left hip pain
Upper back pain in my spine
Slipping disks
Hopelessness
Zero motivation to do anything
Socially withdrawn
Schitzophrenia
Mo memory with numbers or sentence recall

There are more!!!
I feel like the answers are right in front of our face. It seems like the entire medical community doesn’t want us to know or they didn’t go over this in class. Either way. Here’s how I fixed it. Yes I think this could maybe work or help with the conditions I said earlier

Hormones
Dhea. Start 5 to 10 mgs in morning. With or without food. Might upset stomach for first few days
Pregnenolone. 10 mgs. 3 to 4 hours after taking the dhea

Amino acids
L-tyrosine. 500 to 1000 mgs in the morning. This will help u make l dopa. Dopamine norepinephrine and epinephrine. This has to be taken on an empty stomach due to the competing nature of the amino acids in the body. These are the transmitters that will give you back your motivation and many other things!! It really is powerful and safe compared to a lot of other things
Sam-e. this will give you some serotonin back and will helpmyournbady pain
400 mgs on empty stomach. Maybe early afternoon.

Lots of vit c. 2000 to 3000 mgs
And magnesium
B complex
All this is really inexpensive. You could get all 7 things for under 50 dollars.
Doctors don’t know much about this I’m afraid. Doesn’t seem like it to me.
I’m not a doctor. I sometimes am above average at making connections and I pulled out of this with my own grit and I know you guys can too. Hope this helps. Try it for two weeks at least. You might be amazed!!!! I truly was. This was my own research so I don’t have a book or guide to tell about for more study.
Please at least ask your doctors about the hormones if you feel better in the two weeks. Hormones can mess you up if you don’t need them. 4 months is supposed to be a good reference point
And the amino acids need to be looked at if you are already on antidepressant medicines.
Good luck. Really hope this helps

Hi…I have had PTSD for several years from multiple traumatic,events. I only ever had traits. I coped on a day to day level. A one off incident triggered full blown multiple flash backs in 2011. Although i went down into a deep depression i also had the ability to pull my self through the darkness with coping strategies.
My problems started as i was coming out the other side of the depression 6 weeks later.
I worked in a mental health organization and felt safe. Stupidly i disclosed the causes. I was sacked unceremoniously, during which time i was shaking violently hyperventilating and stuttering. the reason I was given that since disclosing no one wanted to work with me and how did i know if someone else had suffered the same fate…I was told to leave the building and not to return. i was then ostracized by the,team.marginalized and treated as if i was the worst maddest person employed by the organization. My work had been excellent. My boss didn’t even have the professionalism to tell anyone of her actions.
Now 3 yrs on i ha e moved and trying to start again. I am once again off sick with ptsd. Just walking into an office is destroying me.

Hi, I was so happy to find this. Quite a number of years ago I was involved in a car accident and I was the only survivor. I lost my entire family.. I never did manage to completely get over everything including the PTSD. I know now the warning signs, noise levels effect, I need to hibernate and I sleep. This happens now and I understand my stresses. Note them down, and times of year.

One year and a half ago when I felt like I was in danger at work for months, and then lost my job of many years, I began intensive therapy. More past traumas surfaced in therapy that I had apparently pushed out of my mind for years. Anyway, it is incredible that now I have jumped into trauma land, and I am having a really hard time getting out of this non amusement park filled with roller coaster rides. I relate to being tired and unable to concentrate. Now I can sleep all day, but that’s not healthy. I am so trying to stay motivated but the pains are greater than lil ole me.